Protecting a baby is a full-time responsibility, even when they are asleep. In the United States, 3,400 babies die annually from sudden unexpected infant death (SUID), according to the Centers for Disease Control and Prevention.  

The CDC considers SUID deaths as SIDS (sudden infant death syndrome), unknown cause of death and accidental suffocation in a bed.  

Babies are most at risk for SIDS from birth to 1 year old.   

Throughout the years, sleeping recommendations for babies have evolved. In 2022, the American Academy of Pediatrics released an updated policy, “Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment,” to keep babies safe as they sleep.   

Ashley Ross, M.D., chief of neonatology and co-medical director for the award-winning Neonatal Intensive Care Unit (NICU) at Arkansas Children’s Hospital (ACH) in Little Rock, said safe sleep recommendations have changed over the years because health care is “dynamic.”   

"I think it's really important to understand that our understanding of science and health care is dynamic, and it changes. We have new techniques to investigate, we have new questions that we can ask and new ways to measure it. And so over time, there can be changes in recommendations, and sometimes it can be hard to keep track of that if you're a parent especially," Ross said. "So it's very important to reach out to your health care provider to understand what is the latest and greatest and best recommendation."   

Safe Sleep Tips   

Ross said there are three tips parents need to remember about safe sleeping environments for babies: 

  • Do not let a baby sleep in bed with you 
  • Always place a baby to sleep on their back
  • Do not place anything in the crib with your baby; only a fitted sheet. 

If a baby is sleeping with you or in a crib with items like toys, stuffed animals, blankets and bumpers, they are at risk of being unable to breathe.   

"Babies are not real mobile in the very beginning, but they can scoot around, and they can get entangled in some of those items that are in the bed. They can get buried in some of those items and have difficulty breathing as a result of it. We know that babies who are not sleeping in a safe sleep situation are at an increased risk of what used to be called, 'crib death,'" now SIDS, Ross said. "And that's really the concern that we have. We know that there are things that we can do to help promote safe sleep and create the best environment for the baby to be healthy."   

The NICU care team, particularly nurses, works with families as they prepare to leave the NICU with their babies. Ross explained when a baby is in the NICU receiving 24/7 care and monitoring, some devices are present in their pod to position them in a certain way, depending on their medical condition. This changes when they are preparing to go home.   

"We start being very vocal about, 'It's time to start taking things out of the bed. It's time to start taking those positioning devices out of the bed.' And literally doing that when we're on rounds seeing patients, demonstrating what a safe sleep environment looks like for the families so they begin to have a model for what they can look at when they go home," Ross said. "Also, nurses are very important. They're the ones that are at the bedside 24 hours a day, and they spend a lot of time talking about safe sleep with families. They spend a lot of time modeling safe sleep."   

Sometimes, that means correcting myths like babies sleeping on their stomachs. Once a standard, it is now dangerous.   

"When it comes to safe sleep, we hear that. We hear that from grandparents who raised their children in a different era. And so, it's not just focusing in on the parent and making sure they understand what safe sleep is; it's really engaging the broader family, so they understand what safe sleep does as well because the recommendations have changed as we've gotten new information, new data," Ross said. "'Back to sleep' has been the standard for a number of years," since the 1990s.   

*This article was written by the Arkansas Children’s content team and medically reviewed by Ashley Ross, M.D. 

Arkansas Children’s Award-Winning NICU 

Arkansas Children's Hospital (ACH) in Little Rock has the only Level 4 NICU in the state. The care team includes 70 specialized neonatal providers, including neonatologists, fellows, APRNs, physician assistants and hospitalist pediatricians. There are more than 250 registered nurses. They provide 24/7 care for about 70 to 80 babies at a time.   

Ashley Ross, M.D., chief of neonatology and co-medical director for the Neonatal Intensive Care Unit (NICU) at ACH, explained the Level 4 status indicates the most comprehensive care.   

"The easiest way to think about it is we provide the most comprehensive services for newborns needing intensive care, and that means that we have all the right doctors and nurses and nurse practitioners," Ross said. "It means that we work very closely with surgical colleagues to ensure that there's every surgical service available. Importantly, it also means we can provide extracorporeal membrane oxygenation or ECMO, which is heart-lung bypass for patients. It really means a comprehensive, full-service neonatal intensive care."   

Babies arrive at the ACH NICU via the Angel One Patient Transport System. Angel One has seven vehicles, including five ground ambulances and two Sikorsky S-76D helicopters. Ross described Angel One as a “mobile intensive care unit.”   

"What parents and physicians and others in the community should know is we're bringing our Level 4 NICU care to your hospital to pick up your baby. The teams that go out are just incredible. They spend lots of time training and simulating so they can be prepared for every scenario they need to be when they go pick up a very sick newborn," Ross said. "It's just an incredible service that we have here at Arkansas Children's Hospital. I literally can just pick up the phone, talk to a referring provider and I know that that baby is going to get the best care possible when the team gets to them."   

 This year, Arkansas Children’s NICU received the Gold-Level Beacon Award for Excellence from the American Association of Critical-Care Nurses (AACN), recognizing the team’s exceptional patient care and work environment. It is one of just 11 NICUs in the nation to receive the honor.   

"For me, it recognizes that it's a team effort. In the NICU and other intensive care units, it doesn't work without a strong team at all levels. It means that you have a strong nursing staff, strong therapists, strong respiratory therapists, your providers are highly engaged and you're constantly looking for opportunities for improvement. That's what this recognition really means. It means that you're really functioning at the highest level you possibly can," Ross said.   

Learn more about the ACH NICU